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California voters go to the polls next Tuesday, March 5th. While the public has heard much of the debate among the presidential candidates regarding healthcare in general, little attention has been paid to the candidates’ positions on mental health. Rather than remaining frustrated by that neglect, I decided to do some digging on my own, as I was also inspired by the recently published Racial Justice Presidential Scorecard. The results I found on mental health were a mixed bag, where some of the candidates demonstrated advocacy and strong support for the cause, others were neglectfully absent. Given the importance of this issue within our community, I sorted through the available information and did some ranking of the candidates based on their past work on the issue, advocacy, and specific policy proposals. I offer the results and my analysis as a voter education guide— not an endorsement of any particular candidate. I encourage you to explore candidate positions on your own. My research was aided by Mental Health US who asked all the candidates to weigh in on their positions. I also reviewed each candidate’s website for specific proposals.

The leader: Elizabeth Warren While several candidates have put forward policy proposals regarding mental health care, none of them have done as much to combine detailed policy work with a thoughtful integration of mental health into policies related to housing, criminal justice, education, workforce development, insurance reform, and veteran’s affairs as Senator Elizabeth Warren. Warren stands out as a leader in her past efforts that none of the others can match. As a Senator she has fought budget cuts to mental health and, along with Elijah Cummings, introduced the CARE Act in 2019, which, if enacted, would increase funding by $100 billion over 10 years to combat the opioid epidemic. It’s a comprehensive proposal that would include increased funding to early intervention and mental health care. Warren has also authored legislation, the Behavioral Health Coverage Transparency Act, which would require insurers to provide adequate mental health benefits. She has worked on expanding community health centers and expanding Medicaid Coverage. She recognizes the importance of addressing the shortage of mental health professionals and has vigorous proposals to deal with that. Warren co-sponsored the Comprehensive Justice and Mental Health Act, which sought to facilitate collaborative mental health supports for people in the criminal justice system. She has also advocated for mental health of youth, foster youth, addressing post-partum depression, increased mental health research, Native American mental health and other related causes.

The solid supporters: Joe Biden, Pete Buttigieg, Amy Klobuchar and Bernie Sanders Vice President Joe Biden does have a record of past support for mental health parity; however, he has made no specific proposals to increase access to mental health care. He has developed vigorous proposals regarding mental health when it comes to children and veterans. Biden has proposed doubling the number of psychologists, nurses, and guidance counselors in schools to address the metal health needs of children and youth. In addition, he has developed a comprehensive proposal to address the suicide epidemic and support the mental health needs among veterans.

Mayor Pete Buttigieg’s proposals are comprehensive and cover the opioid crisis, mental health in the criminal justice system, workforce development, and veteran’s issues. He also recognizes the importance of early intervention. His National Service Plan includes a proposal for a Community Health Corps where youth would learn how to support their peers around mental health and addiction. Buttigieg highlights his commitment to addressing the mental health crisis on his campaign website, including a video and a white paper detailing his proposals.

Senator Amy Klobuchar’s father struggled with alcoholism and she has made combatting substance use disorder a part of her platform. Her proposal, which includes new prevention and early intervention efforts and expands access to care, would be paid for by taxing opioid manufacturers. Senator Klobuchar has also pledged to increase funding for crisis support and training for health departments, first responders, and school personnel. She has advocated for expanding drug and mental health courts as an alternative to incarceration.​Senator Bernie Sanders is well known for proposing “Medicare for All” which would replace the private insurance system with a federal government sponsored program that would cover all Americans. Within that proposal he has made the guarantee that mental health care and substance use treatment would be fully covered. His proposal includes an analysis of health disparities around the country, including racial and geographic disparities, funding to increase reimbursement rates, and other initiatives to address those gaps. In addition, Senator Sanders has pledged to expand the National Health Service to help increase care in underserved communities. He proposes increased funding for K-12 education and funding “sustainable community schools,” which includes funding for increased mental health and substance abuse prevention.

The no shows: Mike Bloomberg, Tulsi Gabbard, and Tom Styer While each of these candidates has made supportive statements regarding mental health and substance abuse, none of them have made serious proposals to address the mental health crisis. Mike Bloomberg has pledged to fight the opioid epidemic, but his only proposal regarding mental health is to enforce existing laws mandating that insurers cover treatment. Similarly, Tom Styer has done no more than make vaguely supportive statements on the issues related to metal health and substance abuse. Tulsi Gabbard has advocated for veteran’s mental health in the past and has co-sponsored legislation in that area; however, she fails to include mental health in her healthcare proposals.​The obstacle: President Donald Trump President Trump’s proposed 2020 budget calls for an additional $53 million to address the opioid and related disease epidemic; however, it also proposes large cuts to Medicaid and Medicare ($777 billion and $600 billion cuts respectively over 10 years) and other health programs ($65 million cut from the Substance Abuse and Mental Health Services Administration) that would more than wash away that increase. White House budget also calls for a more than $236 million cut to chronic disease prevention and health promotion. In addition, the Trump administration has been working to drive down enrollment in the insurance plans under the affordable care act (ACA). Shortening the period of enrollment, slashing funding for marketing enrollment, and cutting funds for ACA navigators succeeded in cutting enrollment in 2020 and increasing the number of uninsured Americans.